CIHM 
Microfiche 


(Monographs) 


ICMH 

Collection  de 
microfiches 
(monographies) 


Canadian  Institute  for  Historical  Microraproductions  /  institut  Canadian  de  microreproductions  historiques 


Ttchnical  and  Bibliographic  Notes  /  Notts  ttchniquas  et  bibliographiqu«s 


The  Institute  has  attempted  to  obtain  the  best  original 
copy  available  for  filming.  Features  of  this  copy  which 
may  be  bibliographically  uoique,  which  may  alter  any 
of  the  images  in  the  reproduction,  or  which  may 
significantly  change  the  usual  mettiod  of  filming,  are 
checked  below. 


L'Institut  a  microfilm*  le  meilleur  exemplaire  qu'il 
lui  a  M  possible  de  se  procurer.   Let  details  de  cet 
exemplaire  qui  sont  peut-4tre  uniques  du  point  de  *ue 
bibliographique,  qui  peuvent  modifier  une  ir^age 
reproduite.  ou  qui  peuvent  exiger  une  modification 
dans  la  mithode  normale  de  f  ilmage  sont  iitdiqu^ 
ci-dessous. 


0  Coloured  covers/ 
Couverture  de  couleur 

□  Covers  damaged/ 
Couverture  endommagia 


□  Coloured  pages/ 
Pages  de  couleur 

□  Pages  damaged/ 
Pages  endommagies 


□  Covers  restored  and/or  laminated/ 
Couverture  restaurie  et/ou  pelliculie 


D 


Covei  title  missing/ 

Le  titre  de  couverture  manque 


□  Pages  c      .t  .  lu  lot  laminated/ 
Pages       a  '.tr^a  :  /ou  pellicultes 

E  Pages  dt.    >   ■\:f'^,  ■^ttintd  or  foxed/ 
Pages  decoiu.     &  t^cheties  ou  piquecs 


D 


Coloured  maps/ 

Cartes  gtographiques  en  couleur 


□  Pages  detached/ 
Pages  detachies 


D 


Coloured  ink  (i.e.  other  than  blue  or  black)/ 
Encre  de  couleur  (i.e.  autre  que  bleue  ou  noire) 

Coloured  plates  and/or  illustrations/ 
Planches  et/ou  illustrations  en  couleur 

Bound  with  other  material/ 
Relie  avec  d'autres  documents 

Tight  binding  may  cause  shadows  or  distortion 
along  interior  margin/ 

La  reliure  serree  peut  causer  de  I'ombre  ou  de  la 
distorsion  le  long  de  la  marge  interieure 

Blank  leaves  added  during  restoration  may  appear 
within  the  text.  Whenever  possible,  these  have 
been  omitted  from  filming/ 
II  se  peut  que  certaines  pages  blanches  ajouties 
lors  d'une  restauration  appjraissent  dans  le  texte, 
mais,  lorsque  cela  etait  possible,  ces  pages  n'ont 
pas  ete  filmees. 


HShowthrough/ 
Transparence 


Quality  of  print  varies/ 
Quiilite  inigale  de  I'impression 

Continuous  pagination/ 
Pagination  continue 

Includes  Index(es)/ 
Comprend  un  (des)  index 

Title  on  header  taken  from:/ 
Le  titre  de  I'en-tCte  provient; 


□  Title  page  of  issue/ 
Page  de  titre  de  la  liva 

□  Caption  of  issue/ 
Titre  de  depart  de  la 


I 1  Ge 


depart  de  la  llvraison 

Masthead/ 

Generlque  iperiodiques)  de  la  livraison 


n 


Additional  comments:/ 
Commentaires  supplementaires: 


This  Item  is  filmed  at  the  reduction  ratio  checked  below/ 

Ce  document  est  fllme  au  taux  de  reduction  indiqui  ci-dessous. 

^0x  ^4X  18X 


22X 


26  X 


XX 


s 


20X 


12X 


1«X 


24X 


28  X 


32  X 


Th«  copy  filmtd  h«r«  hat  bMn  raproduead  thanka 
to  tha  ganaroaity  of: 

Academy  of  Medicine  Collection 
The  Toronto  Hospital 

Tha  imagaa  appaaring  hara  ara  tha  baat  quality 
poaaibia  eonaidaring  tha  condition  and  lagibiiity 
of  tha  original  copy  and  in  kaaping  with  tha 
filming  contract  apacif leationa. 


Original  co^ioa  in  printad  papar  covara  ara  fllmad 
baginning  with  tha  front  covar  and  anding  on 
tha  iaat  paga  with  a  printad  or  illuatratad  Improa- 
aion.  or  tha  back  covar  whan  appropriata.  All 
othar  original  copiaa  ara  filmad  baginning  on  tha 
firat  paga  with  a  printad  or  illuatratad  impraa- 
aion.  and  anding  on  ttta  Iaat  paga  with  a  printad 
or  illuatratad  impraaaion. 


Tha  iaat  racordad  frama  on  aach  mieroflcha 
ahail  contain  tha  symbol  — ^  (maaning  "CON- 
TINUED"), or  tha  symbol  ▼  (maaning  "END"), 
whichavar  appliaa. 

Mapa.  plataa.  charts,  ate.  may  ba  filmad  at 
diffarant  raductlon  ratioa.  Thosa  too  iarga  to  ba 
antiraly  includad  in  ona  axpoaura  ara  filmad 
baginning  in  tha  uppar  iaft  hand  comar.  iaft  to 
right  and  top  to  bottom,  as  many  framaa  as 
raquirad.  Tha  following  diagrama  illuatrata  tha 
mathod: 


L'axamplaira  film*  fut  raproduit  grica  *  la 
g*n4rosit*  da: 

Academy  of  Medicine  Collection 
The  Toronto  Hospital 

Las  imagas  suivantas  ont  At*  raproduitas  avae  la 
plus  grand  soin,  compta  tanu  da  la  condition  at 
da  la  nattat*  da  l'axamplaira  film*,  at  an 
conformit*  avac  iaa  conditions  du  contrat  da 
filmaga. 

Laa  axamplairaa  originaux  dont  la  couvartura  an 
papiar  aat  imprim4a  sont  filmis  an  commandant 
par  la  pramiar  plat  at  an  tarminant  soit  par  la 
darniira  paga  qui  comporta  una  amprainta 
d'impraasion  ou  d'lllustration,  soit  par  la  sacond 
plat,  aalon  la  caa.  Tous  las  autras  axamplairas 
originaux  sont  filmis  an  commandant  par  la 
prami*ra  paga  qui  comporta  una  amprainta 
d'impraaaion  ou  d'lllustration  at  an  tarminant  par 
la  darniira  paga  qui  comporta  una  talla 
amprainta. 

Un  daa  aymbolaa  suivants  apparaitra  aur  la 
darni*ra  imaga  da  chaqua  microfiche,  salon  la 
cas:  la  symbols  — »•  signifia  "A  SUIVRE".  la 
symbols  ▼  signifia  "FIN". 

Laa  cartaa.  planchaa.  tableaux,  ate.  pauvant  itra 
filmfo  i  daa  taux  da  reduction  diff«rants. 
Lorsqua  la  document  ast  trop  grand  pour  ttra 
raproduit  an  un  saul  clich*.  ii  ast  film*  *  partir 
da  I'angia  sup*riaur  gaucha.  da  gauche  i  droita, 
at  da  haut  an  bas,  an  pranant  la  nombra 
d'imagaa  n*cassaira.  Las  diagrammas  suivants 
illustrant  la  m*thoda. 


1  2  3 


6 


MICROCOPY   RfSOlUTION   TBT  CHART 

(ANSI  and  ISO  TEST  CHART  No.  2) 


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VIENN  \  AFTER 
THIRTY- FOUR  YEARS 

BY 

WILLIAM  OSLER,  M.D. 

Regitu  Prqfettor  of  Medicine 
at  the  Umvertity  of  Oxford,  Oxford,  England 


VIENNA 
AFTER  THIRTY-FOUR  YEARS* 


I  SPENT  the  first  four  months  of  1874  here. 
I  came  from  Berlin  with  Hutchinson,  an 
Edinburgh  man  (Sir  Charles  F.,  who  has  re- 
cently died),  and  we  1'"  d  together  near  the  All- 
gemeines  Krankenhaus.  \s  illustrating  the  total 
blotting  out  of  certain  memories,  particularly 
for  places,  I  may  mention  that  strolling  to-day 
up  the  Alserstrasse  I  could  not  recall  the  street, 
much  less  the  house,  where  we  had  lived  for  the 
four  months.  I  found  my  way  readily  enough  to 
the  Riedhoff,  where  we  were  in  the  habit  of  din- 
ing, and  where  I  first  met  my  old  friends,  Fred 
Shattuck,  E.  H.  Bradford,  E.  G.  Cutler  and 
G.  K.  Sabine  of  Boston.  An  extraordinary  de- 
velopment has  taken  place  in  the  city  within 
thirty  years,  and  I  scarcely  recognized  the  Ring- 
strasse.  Then,  only  the  foundations  of  the  new 
university  buildings  and  of  the  Rathaus  had 
been  begun.  Now  these,  with  the  parliament 
house,  the  cour^^s  of  justice,  the  twin  museums 
of  art  and  natural  history  and  the  new  Bourg 

*  Reprinted  from  the  Journal  of  the  American  Medical  Association, 
60:  1623.  1908. 


8 


VIENNA 


Theater,  form  a  group  of  buildings  unrivaled  in 
any  city. 

THE  GERMAN  CONGRESS  FOR  INTERNAL  MEDICINE 

Tlie  primary  object  of  my  visit  was  to  attend 
the  Congress  fur  Innere  3fedizin,  and  I  had  the 
pleasure  of  having  with  me  my  old  student  and 
friend.   Dr.   Joseph   H.   Pratt  of  Boston.   We 
reached  Vienna  in  time  for  the  preliminary  Sun- 
day evening  social  gathering  in  the  Kursu.      jf 
the  City  Park.  Here  we  foc  nd  a  greeting  in  tn-- 
German  fashion  and  a  hearty  welcome  from  the 
president,    Professor   MuUer  of  Munich.   The 
work  of  the  congress  began  at  sharp  9:30  on 
Monday  morning  with  a  discussion  on  the  "Re- 
lation of  the  Diseases  of  the  Female  Generative 
Organs  to  Internal  Maladies."  Unfortunately, 
the  large  University  Hall,  in  which  the  meeting 
was  held,  was  most  unsuitable.  Though  seated 
not  very  far  away.  Professor  Rosthorn's  remarks 
were  almost  inaudible.  It  is  a  miserable  mistake 
in  introducing  a  discussion  on  any  subject  to 
speak  for  more  than  half  an  hour,  but  to  continue 
for  an  hour  and  a  quarter  is  too  much  for  human 
endurance,  and  a  great  many  did  not  wait  for 
Professor  Lenhartz's  discussion  of  the  problem 
from  the  standpoint  of  internal  medicine.  Noth- 


AFTER  THIRTY-FOUR  YEARS 


ing  new  was  brought  out,  and  so  far  as  I  could 
gather,  Professor  Rosthorn  took  much  the  same 
ground  as  Clifford  Allhutt  in  his  well-known 
Goulstonian  lectures  dealing  with  the  intimate 
relationship  through  the  sympathetic  nervous 
system  of  the  generative  functions  with  those  of 
the  other  organs. 

Quite  an  animated  discussion  followed,  in 
which  Stintzing,  Turban,  Klemperer  and  others 
took  part.  Dr.  Singer  read  a  most  interesting 
paper  on  "Intestinal  Diseases  in  the  riimac- 
teric,"  calling  attention  particularly  to  ' Vequent 
hemorrhages  which  he  had  known  to  arouse  sus- 
picion of  malignant  disease. 

In  the  evening  the  city  fathers  gave  a  mt-gnif i  - 
cent  banquet  to  the  congress  in  the  superb  hall 
of  the  Rathaus.  At  three  long  tables  were  seated 
some  600  guests. 

On  Tuesday  morning  Professor  Neisser  of 
Breslau  opened  the  discussion  on  the  "Present 
Position  of  the  Pathology  and  Therapy  of  Syph- 
ilis." This  was  a  splendid  address,  delivered  with- 
out notes,  in  a  good  clear  voice,  and  the  subject 
matter  arranged  in  a  most  order' ^  manner.  He 
dealt  particularly  with  the  three  points  brought 
out  by  recent  investigations — Schaudinn's  dis- 
covery of  the  spirochete,  the  discovery  of  Metch- 


4  VIENNA 

nikoff  that  apes  could  be  infected,  and  the  dis- 
covery of  Schaudinn  that  the  fluids  of  infected 
persons  reacted  specifically.  He  dealt  very  fully 
with  his  own  experimental  work  in  Java,  much 
of  which  has  appeared,  but  it  was  particularly 
interesting  to  hear  the  relation  of  the  extraor- 
dinary influence  of  atoxyl  on  the  infected  ani- 
mals. It  acts  as  a  specific  and  prevents  the  devel- 
opment of  the  spirochetes,  so  that  if  given  soon 
the  disease  could  be  completely  stopped,  and 
later  the  animal  reinfected.  Neisser  was  followed 
by  Professor  Wassermann,  who  described  with 
great  clearness  his  studies  on  the  specific  reac- 
tion. We  have  now  apparently  a  diagnostic 
means  by  which  the  presence  of  the  disease  may 
be  definitely  determined  at  a  very  early  stage. 
As  the  reaction  may  be  present  before  secondary 
symptoms  appear,  it  will  have  a  very  important 
influence  in  early  treatment.  The  general  expres- 
sion of  opinion  is  very  favorable  to  the  method. 
Professor  Finger  spoke  o^  it  to  me  in  the  warm- 
est terms.  It  persists  after  all  clinical  symptoms 
have  disappeared,  and  a  positive  response  in 
locomotor  ataxia  and  in  gencidl  paralysis  clinches 
the  question  of  the  true  syphilitic  nature  of  these 
maladies.  Both  Neisser's  and  Wassermann's 
addresses  were  models. 


.FTER  THIRTY-FO^'.     "EARS  6 

One  of  the  most  import*-;  ;  communications 
of  the  congress  was  from  von  Noorden's  clinic. 
Two  of  his  assistants  have  been  carrying  on  re- 
searches on  the  "Mutual  Relations  of  the  Pan- 
creas and  Thyroid."  For  many  years  von  Noor- 
den  has  had  the  idea  that  there  was  some  impor- 
tant mutual  influence  between  these  two  organs. 
The  remarkable  fact  comes  out  that  in  animals 
frc  ^  which  t}  •  thyroid  gland  has  been  rem  vcd 
it  is  impossibl  o  produce  diabetes  by  any  of  the 
known  methods,  not  even  by  the  Claude  Ber- 
rird  pii.  fjrure  of  the  medulla. 

Of  the  third  day  of  the  congress  I  saw  but 
little.  Professor  Schmidt  of  Halle  introduced  a 
discussion  on  "New  Clinical  Methods  of  Investi- 
gating the  Functions  of  the  Intestine,"  in  which 
he  went  over  his  recent  work  very  fully,  most 
of  which  has  already  been  referred  to  in  The 
Journal. 


DINNER  TO  THE  CONGRESS 

At  the  dinner  of  the  congress  His  threw  out 
the  interesting  suggestion  (apropos  of  the  pres- 
ence of  Grunbaum  and  Trevelyan  from  Leeds, 
Pratt  from  Boston,  Barr  from  Portland,  Ore., 
and  myself),  that  the  time  had  come  to  have  an 
International  Congress  for  Internal  Medicine. 


6  VIENNA 

The  physiologists,  the  laryngologists,  the  alien- 
ists and  others  have  such  gatherings,  and  there 
now  exist  in  France,  Germany  and  Italy,  Eng- 
land and  the  United  States  special  societies  de- 
voted to  internal  medicine.  A  congress  once  in 
four  or  five  years  would  be  most  helpful.  We 
should  get  to  know  each  other  and  be  able  to  ap- 
preciate better  the  work  done  in  different  coun- 
tries. Professor  Schultze  of  Bonn  gave  his  usual 
humorous  sketch  of  the  proceedings  of  the  con- 
gress, which  was  greatly  appreciated.  A  ripple  of 
excitement  spread  around  the  tables  when  it  was 
noticed  that  the  places  in  the  orchestra  of  the 
pianist  and  the  first  violin  had  been  taken  by  von 
Neusser  and  His.  The  members  gathered  around 
the  elevated  gallery  and  the  distinguished  artists 
were  greeted  with  loud  applause  and  had  a 
vigorous  encore. 


THE  VIENNA  LIBRARIES 

Prof.  Max  Neuburger,  whose  name  is  so  well 
known  in  association  with  Pagel  as  editor  of  the 
'' Handbuch  der  Geschichte  der  Medizin,"  very 
kindly  arranged  to  show  me  the  points  of  inter- 
est in  the  Vienna  libraries.  I  may  mention,  by 
the  way,  that  Professor  Neuburger's  new  work 
on  the  "History  of  Medicine,"  of  which  one 


AFTER  THIRTY-FOUR  YEARS  7 

volume  has  appeared,  is  being  translated  and 
will  be  published  from  the  Oxford  University 
Press.  He  expects  to  have  Volume  II  completed 
this  year,  and  we  hope  to  issue  the  English  edi- 
tion complete  in  one  volume  within  the  next 
fifteen  months.  I  was  greatly  interested  to  see 
the  new  home  of  the  Wiener  medizinische  Ge- 
sellschaft,  built  under  the  presidency  of  Billroth, 
which  combines  features  of  a  library,  a  club  and 
meeting  place.  The  auditorium  is  exceptionally 
well  arranged  with  seats  for  300,  and  there  is  a 
large  gallery.  The  library  now  numbers  more 
than  40,000  volumes  and  is  very  rich  in  current 
periodicals.  The  university  library  is  one  of  the 
largest  in  the  city,  and  the  arrangement  in  it  for 
the  accommodation  of  the  medical  students 
seems  to  be  excellent.  At  the  time  of  our  visit 
the  section  of  the  reading  room  assigned  to  them 
was  nearly  full.  A  room  has  been  set  aside  in  con- 
nection with  the  medical  faculty  for  the  collec- 
tion of  all  the  literature  relating  to  the  history  of 
the  school,  for  the  collection  of  the  works  of  all 
the  famous  old  men  connected  with  it,  and  a  re- 
pository for  pictures  and  instruments,  etc.,  the 
wiiole  to  form  a  collection  illustrating  the  evolu- 
tion of  the  history  of  the  medical  department  of 
the  university.  This  example  could  very  well  be 


8 


VIENNA 


followed  in  all  of  our  medical  schools.  It  has 
been  done  to  some  extent  at  the  University  of 
Pennsylvania,  as  William  Pepper  III  has  already 
made  large  collections  for  this  purpose. 

The  Hofhibliothek  is  unusually  rich  in  manu- 
scripts and  early  printed  books.  I  was  anxious  to 
see  the  copy  of  "Christianismi  Restitutio"  of 
Michael  Servetus,  1553,  in  which  for  the  first 
time  the  lesser  circulation  is  described.  This  is 
one  of  the  only  two  known  copies  in  existence. 
The  entire  edition  was  confiscated,  and  the 
author,  at  the  time  a  practitioner  in  the  little 
town  of  Vienne,  near  Lyons,  fled  for  his  life  to 
Geneva.  Here  his  heterodoxy  was  quite  as  ob- 
noxious to  Calvin,  into  whose  hands  he  fell,  and 
he  was  burnt  at  the  stake  in  the  same  year.  The 
"Restitutio"  is  one  of  the  rare  books  of  the 
world.  Only  two  of  the  1,000  copies  known  to 
have  been  printed  have  survived.  The  one  in  the 
Bibliotheque  Nationale  originally  belonged  to 
Dr.  Mead,  and  the  history  is  fully  given  in  an  ap- 
pendix in  Willis'  work,  "Servetus  and  Calvin." 
The  Vienna  copy  is  in  excellent  preservation, 
beautifully  bound,  and  states  on  the  title  page 
that  it  came  from  the  library  of  a  Transylvanian 
gentleman  living  in  London.  It  fell  into  the 
hands  of  Count  de  Izek,  who  presented  it  to  the 


AFTER  THIRTY-FOUR  YEARS 


9 


emperor  of  Austria.  It  is  a  thick,  small  octavo  of 
about  700  pages.  The  first  one  to  give  credit  to 
Servetus  for  his  discovery  of  the  lesser  circu- 
lation was  Wotton,  whose  "Reflections  Upon 
Learning,  Ancient  and  Modern,"  1694,  is  a  most 
interesting  book,  for  an  introduction  to  which 
I  have  long  been  grateful  to  my  friend,  Dr. 
Norman  Moore.  The  other  work  that  I  was  most 
anxious  to  see  was  the  famous  manuscript  of 
Dioscorides,  prepared  at  the  end  of  the  fifth  cen- 
tury for  Julia,  daughter  of  the  Emperor  Flavins. 
It  is  one  of  the  great  treasures  of  the  library. 
Now  to  us  in  the  West  only  a  name,  Dioscorides, 
an  army  surgeon  of  the  time  of  Nero,  fills  a  great 
place  in  the  history  of  medicine,  and  is  still  an 
oracle  in  the  Orient.  He  was  not  only  a  great 
botanist,  but  he  was  one  of  the  first  scientific 
students  of  pharmacology.  Scores  of  fine  edi- 
tions of  his  work,  with  commentaries,  were 
issued  in  the  fifteenth  and  sixteenth  centuries. 
Two  years  ago  this  Vienna  manuscript  was  re- 
produced infac  simile  at  Leyden.  Though  very 
expensive,  the  two  volumes  costing  $150,  it  is  a 
work  which  all  the  larger  libraries  should  get, 
and  it  is  just  the  sort  of  present  librarians  should 
make  our  wealthy  consultants  feel  it  a  privilege 
to  give. 


10 


VIENNA 


THE  HOSPITALS 

I  was  surprised  to  hear  Professor  MuUer  say 
that  he  thought  in  hospital  architecture  Vienna 
led  the  world,  and  that  there  was  here  a  group  of 
architects  who  were  adepts  in  all  matters  relat- 
ing to  hospital  construction.  I  have  come  to  his 
conclusion,  on  what  may  appear  to  be  very  has- 
tily acquired  data.  It  is  not  often  that  in  the 
same  day  and  in  the  same  institution  one  passes 
from  eighteenth  to  twentieth  century  condi- 
tions. Dr.  Koessler  took  us  to  the  old  medical 
clinic,  now  in  charge  of  von  Neusser,  where  I 
found  the  old  wards  very  much  the  same  as  I  re- 
member them  in  1874.  Except  in  minor  details, 
not  only  Oppolzer  and  Skoda,  but  probably  also 
Peter  Frank  and  de  Haen  could  return  to  the 
Allgemeines  Krankenhaus  and  not  be  surprised 
by  any  very  unfamiliar  sights.  There  is  the  same 
extraordinary  wealth  of  clinical  material.  I  must 
say  it  was  a  surprise  to  see  the  old  type  oi  nurse; 
not,  of  course,  that  she  is  necessarily  either  unin- 
telligent or  inattentive.  Indeed,  as  we  passed  a 
bed  in  which  there  was  a  new  patient  whom  the 
junior  assistant  had  not  seen,  he  tur  icd  to  one  of 
the  nuises,  who  in  reply  to  his  question  said, 
"Yes,  Herr says  she  has  mitral  stenosis 


AFTER  THIRTY-FOUR  YEARS 


11 


i 


i 


and  insufficiency!"  I  was  interested  to  see  in  tiie 
ward  a  ease  of  Pick's  disease,  the  pericardial 
pseudoc    rhosis  of  the  liver.  The  old  question 
comes  up  here  as  to  priority  of  descripti  n.  In 
the   special   number   of  the    Wiener   klinische 
Wochenschrift,  issued  for  the  congress,  Professor 
von   Neusser   desciibes   it   as   "Morbus   Bam- 
berger." He  states  that  in  1872  Bamberger  de- 
scribed the  condition  as  a  special  malady  which 
he  had  already  known  for  a  long  time  and  which 
up  to  that  time  had  not  been  recognii.ed  in  the 
literature.  Certainly  Pick  desei  ves  credit  for  hav- 
ing brought  together  all  the  known  facts  relating 
to  a  clinical  condition  to  which  very  little  atten- 
tion had  been  given  before  his  paper.  I  had  a 
most  interesting  talk  with  Pi       :nd  Brauer  and 
Wenckebach  on  the  whole  question,  which  is 
not  one  simply  of  pericardial  adhesion.  Wencke- 
bach has  helped  to  solve  the  problem  in  a  recent 
number  of  Volkman's  Vortrdge  in  an  article  on 
the  "Relation  Between  Respiration  and  Circula- 
tion." Brauer  of  Marburg,  who  is  coming  over 
to  the  session  of  the  American  Medical  Associa- 
tion, will  discuss  the  subject  in  connection  with 
his  operation  of  cardiolysis. 

If  anyone  interested  in  hospitals — in  every 
possible  detail,  construction,  situation,  general 


12 


VIENNA 


arrangements  for  the  comfort  of  the  patients,  for 
the  convenience  of  the  students,  for  the  advancj- 
meui,  of  science— if  such  an  one  wishes  to  have  a 
Queen-of-Sheba  sensation,  let  him  visit  the  first 
group  of  the  new  buildings  of  the  Allegemeines 
Krankenhaus.  They  have  begun  the  rebuilding 
with  the  departments  for  women,  and  two  of  the 
three  clinics,  for  midwifery  and  gynecology,  are 
completed,  one  for  Professor  Schauta  and  the 
other  for  Professor  Rosthorn,  recently  called 
from  Heidelberg.  About  10,000  deliveries  a  year 
take  place  in  the  three  clinics,  one  of  which  is  for 
midwives.  The  new  clinics  are  exact  duplicates 
of  each  other,  and  each  has  accommodation  for 
about  200  patients.  The  buildings  are  of  four 
stories,  a  central  building  with  wings,  built  of 
brick  and  stucco,  with  spacious  corridors,  large 
windows,  tiled  floors  and  white  oil-finished  walls. 
Inside  and  out  they  form  the  most  attractive 
hospital  buildings  that  I  have  ever  seen.  But  it  is 
not  so  much  this  aspect  that  gives  one  that  sink- 
ing of  the  heart  of  v^hich  the  Queen  of  Sheba 
complained  when  Solomon  showed  his  treasures 
—it  is  the  organization  and  the  completeness  of 
the  arrangements  for  teaching  and  for  the  scien- 
tific study  of  disease.  One  large  floor  is  assigned 
to  students,  who  all  live  in  the  building  while 


AFTER  THIRTY-FOUR  YEARS 


IS 


attending  the  midwifery  eases.  Each  clinic  has 
its  own  laboratory,  a  special  museum  for  teach- 
ing purposes,  a  library  and  a  fully  equipped  small 
laboratory  adjoining  the  gynecologic  operating 
room  so  that  an  opinion  may  be  given  immedi- 
ately as  to  the  nature  of  a  growth.  Down  to  the 
smallest  detail  every  care  has  been  taken  to  make 
these  two  clinics  the  most  perfect  of  their  kind, 
and  if  the  hospital  is  completed  on  this  elabo- 
rate plan  it  will,  indeed,  be  worthy  of  the  fame  of 
the  Vienna  school  and  there  will  be  nothing  like 
it  in  Europe  or  America.  The  government  foots 
the  bills,  and  the  total  cost  of  the  two  build- 
ings has  been  9,000,000  kronen  ($1,800,000). 

Professor  Schlesinger  very  kindly  took  us  to 
the  Franz  Josef  Hospital,  also  a  new  building,  on 
a  less  elaborate  scale  but  vary  complete  iu  all  its 
appointments.  It  is  particularly  well  arranged  for 
the  acute  infectious  diseases,  and  the  most  elabo- 
rate precautions  are  taken  to  isolate  and  disin- 
fect the  patients.  Professor  Schlesinger  is  very 
popular  with  American  students,  and  we  found 
working  in  his  wards  Dr.  George  Cheyne  Shat- 
tuck  III  of  Boston,  and  young  Dr.  Fischel  of  St. 
Louis,  both  of  whom  have  for  some  months  been 
acting  as  voluntary  assistants.  It  was  interesting 
to  see  two  wards  devoted  entirely  to  erysipelas; 


14 


VIENNA 


as  far  as  possible  all  the  cases  in  the  city  are  sent 
here.  Connected  with  this  hospital  is  a  beautiful 
new  children's  department,  built  by  Professor 
Schlesin^^er's  father-in-law.  It  looked  to  be  an 
admirable  model  for  the  new  Harriet  Lane 
Johnston's  children's  department  at  the  Johns 
Hopkins  Hospital.  In  the  arrangement  for  iso- 
lating cases,  in  the  simple  and  easily  worked 
character  of  the  wards,  in  the  laboratory  arrange- 
ments and  in  the  special  incubators  for  feeble 
babies  the  hospital  seemed  much  in  advance  of 
anything  I  had  ever  seen. 

The  scientific  laboratories  of  the  medical 
school  have  been  completely  transformed.  Dr. 
Frohlich  took  us  through  Professor  Meyer's 
Pharmacologic  Institute  and  through  the  new 
physiologic  laboratory  and  the  anatomic  depart- 
ment—such a  contrast  to  the  old  days! 

CRITICIS  :l  OF  WORK  Ol    CONGRESS 

The  general  impression  one  gets  of  the  work 
of  the  congress  is  very  favorable.  Too  much,  per- 
haps, is  attempted.  There  are  too  many  papers, 
but  the  keenness  of  the  men  and  the  scientific  in- 
terest are  most  stimulating.  As  I  remarked  about 
the  congress  two  years  ago  in  Munich,  there  is  a 
strong  tendency   in   internal   medicine   to-day 


AFTER  THIRTY-FOUR  YEARS 


16 


toward  physiologic  and  chemical  problems.  On 
the  long  list  of  papers,  eighty-eight  in  number, 
there  were  only  about  five  dealing  with  bacterio- 
logic  questions.  An  extraordinary  number  dealt 
with  questions  in  physiologic  pathology  and 
presented  the  results  of  experimental  work. 


INFLUENCE   OF  VIENNA   ON   AMERICAN  MEDICINE 

As  a  medical  center  Vienna  has  had  a  remark- 
able career  and  her  influence,  particularly  on 
American  medicine,  has  been  very  great.  What 
was  known  as  the  first  Vienna  school  in  the 
eighteenth  century  was  really  a  transference  by 
van  Swieten  of  the  school  of  Boerhaave  from 
Leyden.  The  new  Vienna  school,  which  we 
know,  dates  from  Rokitansky  and  Skoda,  who 
really  made  Vienna  the  successor  of  the  great 
Paris  school  of  the  early  days  of  the  nineteenth 
century.  But  Vienna's  influence  on  American 
medicine  has  not  been  so  much  through  Skoda 
and  Rokitansky  as  through  the  group  of  brilliant 
specialists — Hebra,  Sigmund  and  Neumann  in 
dermatology;  Arlt  and  Jaeger  in  ophthalmology; 
Schnitzler  and  von  Schrotter  in  laryngology; 
Gruber  and  Politzer  in  otology.  These  are  the 
men  who  have  been  more  than  others  responsible 
for  the  successful  development  of  these  special- 


16 


VIENNA 


ties  in  the  United  States.  Austria  may  well  be 
proud  of  what  Vienna's  school  has  done  for  the 
world,  and  she  still  maintains  a  great  reputation, 
though  it  can  not  be  denied,  I  think,  that  the 
Aesculapian  center  has  moved  from  the  Danube 
to  the  Spree.  But  this  is  what  has  happened  in 
all  ages.  Minerva  Medica  has  never  had  her  chief 
temples  in  any  one  country  for  more  than  a  gen- 
eration or  two.  For  a  long  period  at  the  Renais- 
sance she  dwelt  in  northern  Italy,  and  from  all 
parts  of  the  world  men  flocked  to  Padua  and  to 
Bologna.  Then  for  some  reason  of  her  own  she 
went  to  Holland,  where  she  set  up  her  chic." 
temple  at  Leyden  with  Boerhaave  as  her  high 
priest.  Uncertain  for  a  time,  she  flitted  here  with 
Boerhaave 's  pupils,  van  Swieten  and  de  Haen, 
and  could  she  have  come  to  terms  about  a  tem- 
ple, she  doubtless  would  have  stayed  perma- 
nently in  London,  where  she  found  in  John 
Hunter  a  great  high  priest.  In  the  first  four  dec- 
ades of  the  nineteenth  century  she  lived  in 
France,  where  she  built  a  glorious  temple  to 
which  all  flocked.  Why  she  left  Paris,  who  can 
say?  but  suddenly  she  appeared  here,  and  Roki- 
tansky  and  Skoda  rebuilt  for  her  the  temple  of 
the  new  Vienna  school,  but  she  did  not  stay  long. 
She  had  never  settled  in  northern  Germany,  for 


AFTER  THIRTY-FOUR  YEARS 


17 


though  she  loves  art  and  science  she  hates  with  a 
deadly  hatred  philosophy  and  all  philosophical 
systems  applied  to  her  favorite  study.  Her  stately 
Grecian  shrines,  her  beautiful  Alexandrian 
home,  her  noble  Roman  temples,  were  destroyed 
by  philosophy.  Not  until  she  saw  in  Johannes 
Miiller  and  in  Rudolph  Virchow  true  and  loyal 
disciples  did  slie  move  to  Germany,  where  she 
stays  in  spite  of  the  tempting  offers  from  France, 
from  Italy,  from  England  and  from  Austria. 

In  an  interview  most  graciously  granted  to 
me,  as  a  votary  of  long  standing,  she  expressed 
herself  very  well  satisfied  with  her  present  home, 
where  she  has  much  honor  and  is  everywhere 
appreciated.  I  boldly  suggested  that  it  was  per- 
haps time  to  think  of  crossing  the  Atlantic  and 
setting  up  her  temple  in  the  new  world  for  a  gen- 
eration or  two.  I  spoke  of  the  many  advantages, 
of  the  absence  of  tradition — here  she  visibly 
v/eak'^'-'^d,  as  she  has  suffered  so  much  from  this 
poii  1  ihe  greater  freedom,  the  enthusiasm, 
and  tnen  I  spoke  of  missionary  work.  At  these 
words  she  turned  on  me  sharply  and  said:  "That 
is  not  for  me.  We  gods  have  but  one  motto — 
those  that  honor  us  we  honor.  Give  me  the  tem- 
ples, give  me  the  priests,  give  me  t^e  true  wor- 
ship, the  old  Hippocratic  service  of  the  art  and 


18 


VIENNA 


of  the  science  of  ministering  to  man,  and  I  will 
come.  By  the  eternal  law  under  which  we  gods 
live  I  would  have  to  come.  I  did  not  wish  to 
leave  Paris,  where  I  was  so  happy  and  where  I 
was  sei-ved  so  faithfully  by  Bichat,  by  Laennec 
and  by  Louis" — and  tears  fillea  her  eyes  and  her 
voice  trembled  with  emotion — "but  where  the 
worshippers  are  the  most  devoted,  not,  mark 
you,  where  they  are  the  most  numerous;  where 
the  clouds  of  incense  rise  highest,  there  must 
my  chief  temple  be,  and  to  it  from  all  quarters 
will  the  faithful  flock.  As  it  was  in  Greece,  in 
Alexandria,  in  Rome,  in  northern  Italy,  in 
France,  so  it  is  now  in  Germany,  and  so  it  may  be 
in  the  new  world  I  long  to  see."  Doubtless  she 
will  come,  but  not  till  the  present  crude  organi- 
zation of  our  medical  clinics  is  changed,  not  until 
there  is  a  fuller  realization  of  internal  medicine 
as  a  science  as  well  as  an  art. 


